Provider Demographics
NPI:1801211743
Name:WILKERSON, HEIDI DANIELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:DANIELLE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 WINTER WALK CIR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7084
Mailing Address - Country:US
Mailing Address - Phone:843-687-6053
Mailing Address - Fax:
Practice Address - Street 1:3980 HIGHWAY 9 E
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8163
Practice Address - Country:US
Practice Address - Phone:843-390-5217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-01
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18816367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered